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Early recovery in hemodynamics after direct hemoperfusion with polymyxin B-immobilized fibers may predict mortality rate in patients with septic shock

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Abstract

Purpose

This retrospective and observational study attempted to determine whether the rapid improvement in hemodynamic parameters and the subsequent discontinuation or decrease of catecholamine infusion shortly after direct hemoperfusion with polymyxin B-immobilized fibers (PMX) may be strong predictors of mortality in patients with septic shock.

Methods

Retrospectively, 46 patients were divided into two groups; those who survived more than 30 days after PMX (survival group, S group) and those who died within 30 days (nonsurvival group, NS group). Sequential Organ Failure Assessment (SOFA) scores, mean arterial pressure, catecholamine index (CAI), and vasopressor dependency index (VDI) were examined before and after PMX. The same parameters were examined on days 3, 4, 5, 6, 8, and 16 after PMX.

Results

CAI in the S group significantly decreased from 14.7 (95% CI, 10.3–19.1) at baseline to 6.4 (95% CI, 3.7–9.2; P < 0.001) at post-PMX, whereas a significant decrease in CAI was not observed in the NS group (23.1; 95% CI, 15.4–30.7 to 18.1; 95% CI, 11.6–24.7; P = 0.114). The significant decrease in VDI at post-PMX was observed both in the S group and in the NS group. If the cutoff point of VDI at post-PMX is 0.2, there is a significant difference in numbers of the S group (VDI ≥ 0.2, n = 24; VDI < 0.2, n = 2) and NS group (VDI ≥ 0.2, n = 8; VDI < 0.2, n = 20) using Fisher’s exact test.

Conclusions

We concluded that the early improvement in CAI and VDI shortly after PMX might be prognostic indicators for survival.

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References

  1. Kushi H, Miki T, Nakahara J, Okamoto K, Saito T, Tanjo K. Hemoperfusion with an immobilized polymyxin B fiber column reduces the blood level of neutrophil elastase. Blood Purif. 2006;25:212–7.

    Article  Google Scholar 

  2. Kohro S, Imaizumi H, Yamakage M, Masuda Y, Namiki K. Anandamide adsorption by direct hemoperfusion with polymyxin B fiber improves the prognosis and organ failure assessment score in patients with sepsis. J Anesth. 2006;20:11–6.

    Article  PubMed  Google Scholar 

  3. Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A, Malcangi V, Petrini F, Volta G, Pallavicini FB, Rottoli F, Giunta F, Ronco C. Early use of polymyxin B hemoperfusion in abdominal septic shock. JAMA. 2009;30:2445–52.

    Article  Google Scholar 

  4. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286:1754–8.

    Article  CAS  PubMed  Google Scholar 

  5. Vincent JL, de Mendonça A, Cantraine F, Moren R, Takara J, Suter P, Sprung CL, Colardyn F, Blecher S. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicentric, prospective study. Crit Care Med. 1998;26:1793–800.

    CAS  PubMed  Google Scholar 

  6. Aoki H, Kodama M, Tani T, Hanasawa K. Treatment of sepsis by extracorporeal elimination of endotoxin using polymyxin B immobilized fiber. Am J Surg. 1994;167:412–7.

    Article  CAS  PubMed  Google Scholar 

  7. Tsujimoto H, Ono S, Hiraki S, Majima T, Kawarabashi N, Sugasawa H, Kinoshita M, Hiraide H, Mochizuki H. Hemoperfusion with polymyxin B-immobilized fibers reduced the number of CD16+CD14+ monocytes in patients with septic shock. J Endotoxin Res. 2004;10:229–37.

    CAS  PubMed  Google Scholar 

  8. Vincent JL, Laterre PF, Cohen J, Burchardi H, Bruining H, Lerma FA, Wittebole X, Backer DD, Brett S, Marzo D, Nakamura H, John S. A pilot-controlled study of a polymyxin B-immobilized hemoperfusion cartridge in patients with severe sepsis secondary to intra-abdominal infection. Shock. 2005;23:400–5.

    Article  CAS  PubMed  Google Scholar 

  9. Groeneveld ABJ, Bronsveld W, Thijs LG. Hemodynamic determinants of mortality in human septic shock. Surgery (St. Louis). 1986;99:140–52.

    CAS  Google Scholar 

  10. Metrangolo L, Fiorillo M, Friedman G, Silance PG, Kahn RJ, Novelli GP, Vincent JL. Early hemodynamic course of septic shock. Crit Care Med. 1995;25:1095–100.

    Google Scholar 

  11. Uriu K, Osajima A, Kamochi M, Watanabe H, Aibara K, Kaizu K. The severity of hemodynamic circulation may predict the effects of direct hemoperfusion with the adsorbent column using polymyxin B-immobilized fiber in patients with gram-negative septic shock. Ther Apher. 2001;5:25–30.

    Article  CAS  PubMed  Google Scholar 

  12. Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Mets GA, Balk RA. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med. 1987;317:653–8.

    Article  CAS  PubMed  Google Scholar 

  13. Jaber BL, Barrett TW, Cendoroglo Neto M, Sundaram S, King AJ, Pereira BJG. Removal of cytokine inducing substances by polymyxin B-immobilized polystyrene-derivative fibers during in vitro hemoperfusion of 10% human plasma containing Staphylococcus aureus challenge. ASAIO J. 1998;44:48–53.

    Article  CAS  PubMed  Google Scholar 

  14. Tojimbara T, Sato S, Nakajima I, Fuchinoue S, Akiba T, Teraoka S. Polymyxin B-immobilized fiber hemoperfusion after emergency surgery in patients with chronic renal failure. Ther Apher Dial. 2004;8:286–92.

    Article  CAS  PubMed  Google Scholar 

  15. Wang Y, Liu Y, Sarker KP, Nakashima M, Serizawa T, Kishida A, Akashi M, Nakata M, Kitajima I, Maruyama I. Polymyxin B binds to anandamide and inhibits its cytotoxic effect. FEBS Lett. 2000;470:151–5.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, Okayama University School of Medicine and Hospital, Okayama, Japan

    Atsuko Kobayashi & Yoshihito Ujike

  2. Department of the Respiratory Surgery, Saiseikai Suita Hospital, Osaka, Japan

    Yasushi Iwasaki

  3. Department of the Medical Engineering, Saiseikai Suita Hospital, Osaka, Japan

    Yuichi Kimura & Yoshiaki Kawagoe

Authors
  1. Atsuko Kobayashi
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  2. Yasushi Iwasaki
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  3. Yuichi Kimura
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  4. Yoshiaki Kawagoe
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  5. Yoshihito Ujike
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Correspondence to Atsuko Kobayashi.

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Kobayashi, A., Iwasaki, Y., Kimura, Y. et al. Early recovery in hemodynamics after direct hemoperfusion with polymyxin B-immobilized fibers may predict mortality rate in patients with septic shock. J Anesth 24, 709–715 (2010). https://doi.org/10.1007/s00540-010-0986-2

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  • DOI: https://doi.org/10.1007/s00540-010-0986-2

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